BACKGROUND Post-polypectomy syndrome(PPS)is a rare but relevant complication of endo-scopic colorectal polyp removal.Although its course is usually benign,it may conceal more severe conditions.This case report present...BACKGROUND Post-polypectomy syndrome(PPS)is a rare but relevant complication of endo-scopic colorectal polyp removal.Although its course is usually benign,it may conceal more severe conditions.This case report presents several complications resulting from a colorectal polypectomy.CASE SUMMARY We report the case of a 67-year-old man who presented with asthenia and abdo-minal discomfort after a scheduled polypectomy.The patient was initially diagnosed with PPS and managed conservatively.However,progressive clinical deterioration led to hospital admission.Imaging revealed a right-sided intra-abdominal abscess secondary to colonic perforation.The initial polyp was iden-tified as a subepithelial lipoma.The patient underwent successful percutaneous drainage,antibiotic therapy,and recovered without the need for surgical inter-vention.CONCLUSION This case highlights the importance of accurate endoscopic diagnosis and te-chnique selection.PPS should not preclude the consideration of concurrent comp-lications.Early identification and a tailored therapeutic approach can prevent Core Tip:Although therapeutic colonoscopy is generally safe,it may be associated with significant complications.This case illustrates how post-polypectomy syndrome can mask a colonic perforation with subsequent abscess formation.It em-phasizes the importance of an accurate initial endoscopic assessment,the use of advanced resection and closure techniques,and close clinical follow-up.Recognizing this spectrum of complications and intervening early can help prevent major surgical procedures and improve patient outcomes.展开更多
AIM To identify risk factors for post-polypectomy bleeding(PPB), focusing on antithrombotic agents. METHODS This was a case-control study based on medical records at a single center. PPB was defined as bleeding that o...AIM To identify risk factors for post-polypectomy bleeding(PPB), focusing on antithrombotic agents. METHODS This was a case-control study based on medical records at a single center. PPB was defined as bleeding that occurred 6 h to 10 d after colonoscopic polypectomy and required endoscopic hemostasis. As risk factors for PPB, patient-related factors including anticoagulants, antiplatelets and heparin bridge therapy as well as polyp- and procedure-related factors were evaluated. All colonoscopic hot polypectomies, endoscopic mucosal resections and endoscopic submucosal dissections performed between January 2011 and December 2014 were reviewed. RESULTS PPB occurred in 29(3.7%) of 788 polypectomies performed during the study period. Antiplatelet or anticoagulant agents were prescribed for 210(26.6%)patients and were ceased before polypectomy except for aspirin and cilostazol in 19 cases. Bridging therapy using intravenous unfractionated heparin was adopted for 73 patients. The univariate analysis revealed that anticoagulants, heparin bridge, and anticoagulants plus heparin bridge were significantly associated with PPB(P < 0.0001) whereas antiplatelets and antiplatelets plus heparin were not. None of the other factors including age, gender, location, size, shape, number of resected polyps, prophylactic clipping and resection method were correlated with PPB. The multivariate analysis demonstrated that anticoagulants and anticoagulants plus heparin bridge therapy were significant risk factors for PPB(P < 0.0001). Of the 29 PPB cases, 4 required transfusions and none required surgery. A thromboembolic event occurred in a patient who took anticoagulant. CONCLUSION Patients taking anticoagulants have an increased risk of PPB, even if the anticoagulants are interrupted before polypectomy. Heparin-bridge therapy might be responsible for the increased PPB in patients taking anticoagulants.展开更多
BACKGROUND Patients with early oral intake after intestinal surgery achieve better nutritional status and fewer postoperative complications.However,no guidelines or expert consensus have established the optimal timing...BACKGROUND Patients with early oral intake after intestinal surgery achieve better nutritional status and fewer postoperative complications.However,no guidelines or expert consensus have established the optimal timing for diet resumption following colorectal polypectomy.AIM To determine the timing,feasibility,and clinical benefits of early diet resumption following colorectal polypectomy.METHODS In the Second Affiliated Hospital of Zhejiang University School of Medicine,a total of 1502 patients with polyps under 3 cm were recruited and randomly assigned to an experimental group(n=751)and a control group(n=751).Following polypectomy,the experimental group consumed rice soup at 2 hours,while the control group received rice soup at 6 hours.The study focused on delayed post-polypectomy bleeding(DPPB),with secondary evaluation of postpolypectomy perforation,hypoglycemia,fever,and length of stay(LOS).RESULTS The comparison between the two groups revealed no significant differences in DPPB rates(4.7%vs 5.5%,P=0.480)and major bleeding rates(1.5%vs 2.1%,P=0.332).Both groups displayed median bleeding times of 2 days.No notable differences in perforation(0.0%vs 0.3%,P=0.479)and fever rates(2.1%vs 2.9%,P=0.324)were observed between the two groups.However,the experimental group showed significantly lower incidence of hypoglycemia(0.4%vs 1.5%,P<0.05)and shorter LOS[1(1,2)day vs 2(1,2)days,P<0.001]following polypectomy.Subgroup analyses further confirmed that early diet resumption had no adverse effects on patients,irrespective of polyp count,size,pathology,or polypectomy modalities.CONCLUSION Early diet resumption following colorectal polypectomy for polyps not exceeding 3 cm is advisable as it does not significantly increase the risk of complications.展开更多
We recently read with interest the article,“Novel frontiers of agents for bowel cleansing for colonoscopy”.This is a practical narrative review,which could be of particular importance to clinicians in order to impro...We recently read with interest the article,“Novel frontiers of agents for bowel cleansing for colonoscopy”.This is a practical narrative review,which could be of particular importance to clinicians in order to improve their current practice.Although we appreciate the venture of our colleagues,based on our in-depth analysis,we came across several minor issues in the article;hence,we present our comments in this letter.If the authors consider these comments further in their relevant research,we believe that their contribution would be of considerable importance for future studies.展开更多
AIM To determine the frequency and risk factors for colorectal cancer(CRC) development among individuals with resected advanced adenoma(AA)/traditional serrated adenoma(TSA)/advanced sessile serrated adenoma(ASSA). ME...AIM To determine the frequency and risk factors for colorectal cancer(CRC) development among individuals with resected advanced adenoma(AA)/traditional serrated adenoma(TSA)/advanced sessile serrated adenoma(ASSA). METHODS Data was collected from medical records of 14663 subjects found to have AA, TSA, or ASSA at screening or surveillance colonoscopy. Patients with inflammatory bowel disease or known genetic predisposition for CRC were excluded from the study. Factors associated with CRC developing after endoscopic management of high risk polyps were calculated in 4610 such patients who had at least one surveillance colonoscopy within 10 years following the original polypectomy of the incident advanced polyp. RESULTS84/4610(1.8%) patients developed CRC at the polypectomy site within a median of 4.2 years(mean 4.89 years), and 1.2%(54/4610) developed CRC in a region distinct from the AA/TSA/ASSA resection site within a median of 5.1 years(mean 6.67 years). Approximately, 30%(25/84) of patients who developed CRC at the AA/TSA/ASSA site and 27.8%(15/54) of patients who developed CRC at another site had colonoscopy at recommended surveillance intervals. Increasing age; polyp size; male sex; right-sided location; high degree of dysplasia; higher number of polyps resected; and piecemeal removal were associated with an increased risk for CRC developmentat the same site as the index polyp. Increasing age; right-sided location; higher number of polyps resected and sessile endoscopic appearance of the index AA/TSA/ASSA were significantly associated with an increased risk for CRC development at a different site. CONCLUSION Recognition that CRC may develop following AA/TSA/ASSA removal is one step toward improving our practice efficiency and preventing a portion of CRC related morbidity and mortality.展开更多
Glanzmann's thrombasthenia(GT) is a rare autosomal recessive bleeding syndrome characterized by abnormal Glycoprotein Ⅱb/Ⅲa complex(GⅡb/Ⅲa) on platelets with resultant abnormality in platelet aggregation.There...Glanzmann's thrombasthenia(GT) is a rare autosomal recessive bleeding syndrome characterized by abnormal Glycoprotein Ⅱb/Ⅲa complex(GⅡb/Ⅲa) on platelets with resultant abnormality in platelet aggregation.There is very little information regarding polypectomy management in GT.We report a single patient with this rare disease,who underwent sequential endoscopic management of large colon polyps.Polypectomy in our GT patient was complicated by immediate and delayed bleeding.Multiple clips used after standard cautery polypectomy for a polyp 10 mm or larger in our GT patient,was most effective in preventing immediate and delayed post-polypectomy bleeding than other known therapeutic approaches.We favor preemptive use of multiple clips in large polypectomy defects for GT patients and we may argue the added cost may be offset by the reduction in the need for blood products,and by averting or shortening potential hospitalizations.展开更多
Many quality indicators have been proposed for colonoscopy,but most colonoscopists and endoscopy groups focus on measuring the adenoma detection rate and the cecal intubation rate.Use of proper screening and surveilla...Many quality indicators have been proposed for colonoscopy,but most colonoscopists and endoscopy groups focus on measuring the adenoma detection rate and the cecal intubation rate.Use of proper screening and surveillance intervals is another accepted key indicator but it is seldom evaluated in clinical practice.Bowel preparation efficacy and polyp resection skills are areas that are emerging as potential key or priority indicators.This review summarizes and provides an update on key performance indicators for colonoscopy quality.展开更多
文摘BACKGROUND Post-polypectomy syndrome(PPS)is a rare but relevant complication of endo-scopic colorectal polyp removal.Although its course is usually benign,it may conceal more severe conditions.This case report presents several complications resulting from a colorectal polypectomy.CASE SUMMARY We report the case of a 67-year-old man who presented with asthenia and abdo-minal discomfort after a scheduled polypectomy.The patient was initially diagnosed with PPS and managed conservatively.However,progressive clinical deterioration led to hospital admission.Imaging revealed a right-sided intra-abdominal abscess secondary to colonic perforation.The initial polyp was iden-tified as a subepithelial lipoma.The patient underwent successful percutaneous drainage,antibiotic therapy,and recovered without the need for surgical inter-vention.CONCLUSION This case highlights the importance of accurate endoscopic diagnosis and te-chnique selection.PPS should not preclude the consideration of concurrent comp-lications.Early identification and a tailored therapeutic approach can prevent Core Tip:Although therapeutic colonoscopy is generally safe,it may be associated with significant complications.This case illustrates how post-polypectomy syndrome can mask a colonic perforation with subsequent abscess formation.It em-phasizes the importance of an accurate initial endoscopic assessment,the use of advanced resection and closure techniques,and close clinical follow-up.Recognizing this spectrum of complications and intervening early can help prevent major surgical procedures and improve patient outcomes.
文摘AIM To identify risk factors for post-polypectomy bleeding(PPB), focusing on antithrombotic agents. METHODS This was a case-control study based on medical records at a single center. PPB was defined as bleeding that occurred 6 h to 10 d after colonoscopic polypectomy and required endoscopic hemostasis. As risk factors for PPB, patient-related factors including anticoagulants, antiplatelets and heparin bridge therapy as well as polyp- and procedure-related factors were evaluated. All colonoscopic hot polypectomies, endoscopic mucosal resections and endoscopic submucosal dissections performed between January 2011 and December 2014 were reviewed. RESULTS PPB occurred in 29(3.7%) of 788 polypectomies performed during the study period. Antiplatelet or anticoagulant agents were prescribed for 210(26.6%)patients and were ceased before polypectomy except for aspirin and cilostazol in 19 cases. Bridging therapy using intravenous unfractionated heparin was adopted for 73 patients. The univariate analysis revealed that anticoagulants, heparin bridge, and anticoagulants plus heparin bridge were significantly associated with PPB(P < 0.0001) whereas antiplatelets and antiplatelets plus heparin were not. None of the other factors including age, gender, location, size, shape, number of resected polyps, prophylactic clipping and resection method were correlated with PPB. The multivariate analysis demonstrated that anticoagulants and anticoagulants plus heparin bridge therapy were significant risk factors for PPB(P < 0.0001). Of the 29 PPB cases, 4 required transfusions and none required surgery. A thromboembolic event occurred in a patient who took anticoagulant. CONCLUSION Patients taking anticoagulants have an increased risk of PPB, even if the anticoagulants are interrupted before polypectomy. Heparin-bridge therapy might be responsible for the increased PPB in patients taking anticoagulants.
基金Supported by National Natural Science Foundation of China,No.82073160.
文摘BACKGROUND Patients with early oral intake after intestinal surgery achieve better nutritional status and fewer postoperative complications.However,no guidelines or expert consensus have established the optimal timing for diet resumption following colorectal polypectomy.AIM To determine the timing,feasibility,and clinical benefits of early diet resumption following colorectal polypectomy.METHODS In the Second Affiliated Hospital of Zhejiang University School of Medicine,a total of 1502 patients with polyps under 3 cm were recruited and randomly assigned to an experimental group(n=751)and a control group(n=751).Following polypectomy,the experimental group consumed rice soup at 2 hours,while the control group received rice soup at 6 hours.The study focused on delayed post-polypectomy bleeding(DPPB),with secondary evaluation of postpolypectomy perforation,hypoglycemia,fever,and length of stay(LOS).RESULTS The comparison between the two groups revealed no significant differences in DPPB rates(4.7%vs 5.5%,P=0.480)and major bleeding rates(1.5%vs 2.1%,P=0.332).Both groups displayed median bleeding times of 2 days.No notable differences in perforation(0.0%vs 0.3%,P=0.479)and fever rates(2.1%vs 2.9%,P=0.324)were observed between the two groups.However,the experimental group showed significantly lower incidence of hypoglycemia(0.4%vs 1.5%,P<0.05)and shorter LOS[1(1,2)day vs 2(1,2)days,P<0.001]following polypectomy.Subgroup analyses further confirmed that early diet resumption had no adverse effects on patients,irrespective of polyp count,size,pathology,or polypectomy modalities.CONCLUSION Early diet resumption following colorectal polypectomy for polyps not exceeding 3 cm is advisable as it does not significantly increase the risk of complications.
文摘We recently read with interest the article,“Novel frontiers of agents for bowel cleansing for colonoscopy”.This is a practical narrative review,which could be of particular importance to clinicians in order to improve their current practice.Although we appreciate the venture of our colleagues,based on our in-depth analysis,we came across several minor issues in the article;hence,we present our comments in this letter.If the authors consider these comments further in their relevant research,we believe that their contribution would be of considerable importance for future studies.
基金Supported by the National Cancer Institute,No.CA170357the Mayo Clinic Center for Cell Signaling in Gastroenterology,NIDDK Mo.P30DK084567
文摘AIM To determine the frequency and risk factors for colorectal cancer(CRC) development among individuals with resected advanced adenoma(AA)/traditional serrated adenoma(TSA)/advanced sessile serrated adenoma(ASSA). METHODS Data was collected from medical records of 14663 subjects found to have AA, TSA, or ASSA at screening or surveillance colonoscopy. Patients with inflammatory bowel disease or known genetic predisposition for CRC were excluded from the study. Factors associated with CRC developing after endoscopic management of high risk polyps were calculated in 4610 such patients who had at least one surveillance colonoscopy within 10 years following the original polypectomy of the incident advanced polyp. RESULTS84/4610(1.8%) patients developed CRC at the polypectomy site within a median of 4.2 years(mean 4.89 years), and 1.2%(54/4610) developed CRC in a region distinct from the AA/TSA/ASSA resection site within a median of 5.1 years(mean 6.67 years). Approximately, 30%(25/84) of patients who developed CRC at the AA/TSA/ASSA site and 27.8%(15/54) of patients who developed CRC at another site had colonoscopy at recommended surveillance intervals. Increasing age; polyp size; male sex; right-sided location; high degree of dysplasia; higher number of polyps resected; and piecemeal removal were associated with an increased risk for CRC developmentat the same site as the index polyp. Increasing age; right-sided location; higher number of polyps resected and sessile endoscopic appearance of the index AA/TSA/ASSA were significantly associated with an increased risk for CRC development at a different site. CONCLUSION Recognition that CRC may develop following AA/TSA/ASSA removal is one step toward improving our practice efficiency and preventing a portion of CRC related morbidity and mortality.
文摘Glanzmann's thrombasthenia(GT) is a rare autosomal recessive bleeding syndrome characterized by abnormal Glycoprotein Ⅱb/Ⅲa complex(GⅡb/Ⅲa) on platelets with resultant abnormality in platelet aggregation.There is very little information regarding polypectomy management in GT.We report a single patient with this rare disease,who underwent sequential endoscopic management of large colon polyps.Polypectomy in our GT patient was complicated by immediate and delayed bleeding.Multiple clips used after standard cautery polypectomy for a polyp 10 mm or larger in our GT patient,was most effective in preventing immediate and delayed post-polypectomy bleeding than other known therapeutic approaches.We favor preemptive use of multiple clips in large polypectomy defects for GT patients and we may argue the added cost may be offset by the reduction in the need for blood products,and by averting or shortening potential hospitalizations.
文摘Many quality indicators have been proposed for colonoscopy,but most colonoscopists and endoscopy groups focus on measuring the adenoma detection rate and the cecal intubation rate.Use of proper screening and surveillance intervals is another accepted key indicator but it is seldom evaluated in clinical practice.Bowel preparation efficacy and polyp resection skills are areas that are emerging as potential key or priority indicators.This review summarizes and provides an update on key performance indicators for colonoscopy quality.
